Cable TV hosts are talking nonstop about the Supreme Court’s decision on President Barack Obama’s health care law. Politicians are waiting anxiously for it. And the health industry is plotting to win the aftermath.

In corporate suites, K Street conference rooms, and Wall Street investment shops, industry players haven’t all been content to wait and see what the court does.

The war-gaming over the law — the Affordable Care Act — has been particularly intense for insurers and retailers, who are preparing for a doomsday scenario in which the law’s individual mandate is struck down but other provisions are left intact. If insurers are required to cover folks with pre-existing conditions, but young and healthy consumers aren’t required to buy health plans, premiums will skyrocket.

“It would be a worse mess than we already have” with the health care law, Neil Trautwein, vice president of the National Retail Federation, said.

Major hospitals and health care systems have been developing their playbooks, too.

“Obviously everyone is waiting with bated breath about what’s going to happen. There’s lot of talk and gaming out under different scenarios,” said Harold Ickes, a lobbyist who served as deputy chief of staff to President Bill Clinton. “What we do for our clients is lay out different scenarios.”

But Ickes and Delos Cosgrove, CEO of the Cleveland Clinic, said that health providers already have been moving toward giving care in the ways prescribed by the health care law, and that will continue even if the law is fully or partially struck down.

“I think what we’re going to see is just a slowing of the pace of that progress,” said Cosgrove, whose hospital is frequently cited by Obama and others as a model health provider. The law, he said, “put milestones in place and pressed the change.”

While the White House has said it will be ready to react to any ruling, top administration officials aren’t saying a word about the architecture of their plans — other than repeating the talking point that “we’ll be ready.”

That’s what state insurance commissioners reported after meeting Tuesday with Marilyn Tavenner, the acting chief of the Center for Medicare and Medicaid Services, and two officials from the federal government’s insurance oversight agency.

The administration officials didn’t talk about specific responses to the various Supreme Court scenarios, several commissioners said.

“Our discussion was more around how do we keep the lines of communications open,” said Kansas Insurance Commissioner Sandy Praeger, who holds a post once occupied by Health and Human Services Secretary Kathleen Sebelius.

Praeger says she expects that the National Association of Insurance Commissioners will hold conference calls Thursday and Friday to discuss how to respond to the ruling — but that Kansas Gov. Sam Brownback probably will still oppose doing anything to implement the law before the election, even if it survives. She says she hasn’t had any discussions with him about a response.

Rhode Island Health Insurance Commissioner Christopher Koller, however, isn’t exactly planning a rapid response. He says it will take his office at least two weeks to digest the ruling.

Insurance companies are trying to position themselves to withstand a public backlash if they’re thrust back into the position of deciding who gets covered and who doesn’t.

Readers' Comments (67)

I love Senator Kyle's Response. IT is completely counter factual. The ACA, according to the CBO, will lower the costs of health insurance while expanding care to about 96% of Americans.

The law isn't even in effect yet, and the CBO says it will improve budgetary issues, and the CBO has been right on Medicare Part D and the Bush tax cuts, and Kyle is claiming that he has to clean up a mess that has not even happened. A mess that, according to the facts from the only and pretty accurate scorer of legislation in town, is NOT actually a mess.

If the law survives, and Obama is reelected. It will move forward and it will save money, as almost any universal plan would have done a better job as the pre-health reform status quo would. It will be altered and fixed and tweaked.

And then Barack Obama and the Democrats will get credit for the universal healthcare in this country, because they passed the Republican idea supported by Republicans, and not Democrats, until 2009.

You can just see Mitt Romney in 2024 interviews saying, "Ah, you know. Ah, I'am actually the 'Godfather' of Obamacare. (nervous weasely Romney laugh)."

The irony.

$10,000 bet: With Roberts writing the ACA opinion coming out Thursday, the entire law will be upheld in a 6-3 narrow majority opinion.

The poor liberal media is going bonkers over the health care Fiasco and lobbyist agenda. Hardly anyone in the administration or the Congress read the legislation - Nancy P said wait till its signed before you find out what is in it..

Obama's DOJ Representative was lost in trying to defend it

- WE shall see if we have an independed judiciary or just more Obama stooges like the press and Senate.

Look, Obama brought this on himself. With a Super Majority he thwarted everything else ( Jobs/Economy ) while he took one of the last remaining Radical Progressive Trophy Entitlements and handed it over to Pelosi and Reid to do with as they will, allowed them to do what ever deal or bribe it took to pass, against a huge percentage of the publics wishes, and that they did.

A 2300 page bill Deemed passed on a partisan basis, through a budgetary Reconciliation Act on a Christmas Eve no doubt.

This is Obamas Legacy, and as far as Im concerned he can have it. He ruined his Radical Progressive self by allowing the Radical Progressive Pelosi to run the Obamacare Show while he traveled the world in AF1 with not only his family but every one from Opra to now Bon Jovi, Both of who have jets questionably nicer than AF1 itself.

This not only has bad Karma written all over it, its left such a bad taste in our countries collective mouths that no one but the richest of the rich want to give Obama enough money to even stay in his own re election race, that is, if they havent renounced their citizenship by now because of Taxmagedon coming around the corner.

Democratic Politicians again like 2010 want nothing more than Obama to NOT call them for a campaign event. They also are signing on to Holders Contempt Vote because of his and Obamas presumable involvement with/in the botched Fast and Furious / Second Amendment Scandal.

And the SCOTUS/Dreamnasty/Executive Order/Fiat... What does a cop ask each and every driver the second they roll down the window of their vehicle...

" License, Registration and Proof of Insurance Please? ". Three documents, with American Origins, pushed by progressives, by law, years ago.

The Mans a Radical taking Radical Pointers strait out of the Radical Hippie Books of the Sixties and every concerned American should publicly paint him as one, every day, until the election.

There is nothing wrong with a little accountability for our auctions. I shouldn't ask Curt22 or Loretta, or Danbury to pay for my kids' health care and I don't expect them to demand me to pay for theirs.

You'd think a country so full of smart people (liberals), we'd have more common sense!

The individual mandate is going to be overturned. Of this I'm certain.

How much of the law remaining is still an open question. If I had to bet, I'd say it gets struck down in its entirety, because it's just too convoluted to maintain without the funds raised through the mandate. Politically, I don't see it surviving without the mandate; but, the court doesn't have political considerations at the top of their priorities.

If the law survives, and Obama is reelected. It will move forward and it will save money

--------------------------

And if it doesn't save us money, what are you gonna do or who will you blame? GW Bush? It is time to open your eyes to reality. President Obama, the law professor and the smart president, has done more damage to America in 3 years that GW Bush ever did in 8.

Not to mention, President Obama will have 3 strikes against him on cases sent to the SCOUS. So much for someone who sold you the bill of good that he knew the Constitution. Talk about an extremist, radical, activist President, hah?

You would NEVER had put up with this during the Bush era, why are you now setting your standards so low?

The individual mandate is going to be overturned. Of this I'm certain.

How much of the law remaining is still an open question. If I had to bet, I'd say it gets struck down in its entirety, because it's just too convoluted to maintain without the funds raised through the mandate. Politically, I don't see it surviving without the mandate; but, the court doesn't have political considerations at the top of their priorities.

I agree, but also I think each and every Justice went to their chambers after the Hearings and looked at the foot + deep bill on their desks and immediately decided that Scalias 8th Amendment reference was humorously correct for/in their capacities.

Then they went to lunch and said " you know what, Screw Congress, let'em start all over again ".

With practical bipartisan adjustments, ACA could be a potent force for Job Creation.

We all know that health benefits have become the biggest labor cost outside of actual wages. If individuals have a viable way to access health insurance on our own, small business hiring would increase due to their reduction in labor costs. Large corporations have an unfair advantage because large employee pools decrease their per-capita cost of healthcare coverage. This is one reason why we have not seen small businesses lead us out of recession to the extent we have seen in the past.

(The other major reason that small business activity has been stymied is lack of adequate bank lending and the destruction of home equity. Home equity loans historically have been a major source of small and start-up business capital.)

Assuming that individual health insurance is truly accessible under reasonable terms some day, Congress could make it more affordable for low and middle income individuals by replacing EIC and "Making Work Pay" Credit with a refundable healthcare tax credit, using the individual's actual insurance cost as a reasonable portion of income.

Having a national crazy quilt of different insurance rules for different states is one of the major problems with our healthcare system. The insurance industry has fostered this mechanism to create local monopolies with little to no choice within each state. Purchasing insurance from other states does not fix the problem of cherry-picking healthy subscribers to maximize profit.

We do not have state-by-state Medicare premiums and exclusions for seniors, where every state can offer whatever they want - or nothing at all. This is just one reason why Medicare works for patients and no senior wants to give it up. How would people decide where to retire if they had to factor in state-specific Medicare rules? This is what happens today with employment decisions - if you relocate, you lose your coverage and are subject to premium and/or coverage discrimination for pre-existing conditions, so many people are locked and can't move. This barrier to worker mobility hurts our economy. The current system is a Job Killer.

If SCROTUS kills ACA, Obama should provide universal individual health insurance access to the FEHB health plan menu that members of Congress and SCROTUS have for themselves (at our expense), and make it a full, 100% tax deduction on individual tax returns.

The individual mandate could be replaced with a continuous coverage requirement, similar to HIPPA, to provide viable and fair coverage choices for patients with pre-existing conditions.

As long as an individual has maintained uninterrupted insurance coverage, they should be able to shop for competing plans on a guaranteed-issue, community-rated basis - no tricks, exclusions, loopholes, etc. to discriminate for pre-existing conditions or gender or age. This should allow for the comparison shopping and purchase of guaranteed-issue, community-rated insurance immediately upon job loss and/or relocation and/or change in family status and/or simple desire for a better deal - with no waiting period and no discrimination.

The cost of health insurance should be 100% deductible on the individual tax return, without the 7.5% AGI floor. Businesses don't have a 7.5% AGI floor, so why are individuals penalized? Low income individuals could be allowed a refundable tax credit if their insurance cost exceeds a reasonable portion of their AGI.

Members of Congress have unrestricted lifetime access to FEHB upon leaving their job and they are exempt from COBRA limits. Why should ordinary citizens be subject to healthcare discrimination with COBRA limits and exclusions?

The rest of ACA could remain intact and be adjusted by Congress as needed.

Medicare is popular with seniors because Medicare works for the patient. The hodgepodge of providers who seek profit at taxpayer expense insist the program is "broken" and "underfunded." Doctors and hospitals want higher fees and reimbursement. Drug companies and medical device/supply companies and insurance companies want higher profits. There is a good reason why Singapore used Medicare as the model for their national heatlhcare program - it works for patients and it contains costs. The best idea for America is Medicare for everyone - and that includes terminating Medicaid and VA to roll all patients into Medicare.

Medicare funding is an easy fix. Apply FICA to all income regardless of source - i.e. earned and unearned without caps, limits, preferences and exclusions.

It appears that even more citizens and small businesses will have to go broke under the current system before we take the step to single payer. Until then, every American citizen should have healthcare access equal to our elected "representatives" and SCOTUS. Otherwise, government has no incentive to improve healthcare for ordinary citizens.

When Medicare was introduced in the 1960's, the democratic idea was to drop the eligibility age incrementally over subsequent years until America eventually ended up with Medicare for all. By shedding costly seniors, the insurance industry was profitable and coverage was offered through employers at a reasonable cost, and the very largest employers were often self-insured, so Congress never implemented the gradual expansion of Medicare.

Up until the mid-1990's, employer and individual insurance was largely offered through not-for-profit BlueCross/BlueShield franchises. BC/BS was so pervasive that they might be considered a universal payor for subscribers outside of Medicare, Medicaid, VA, and self-funded employers. The Blues were a true insurance pool with many healthy subscribers to cover their medical losses. Doctors liked the Blues because they reimbursed at "reasonable and customary" charges, compared to Medicare which used a fee schedule.

The not-for-profit BC/BS system worked well until the for-profit HMOs took over in the mid-1990's. These profiteering HMO's accessed the stock market and bought up the not-for-profit BC/BS franchises. It was here that we saw the emergence of complex discriminatory policies like rescission, exclusion for pre-existing conditions, coverage limits, etc. Doctors resent the fee schedules (borrowed from Medicare) and exclusive provider networks and pre-approval/denial nightmares, but it is better than being locked out of the subscriber pool.

The steady progression of cherry-picking subscribers and increasing profit margins since the mid-1990's have brought us to the tipping point. The system is no longer sustainable. Small businesses cannot afford to offer insurance. The cost of insurance erodes wage and salary growth. One half of all personal bankrupties are related to health care costs - and a great many of those going bankrupt have insurance.

The insurance companies have successfully lobbied government to maintain the status quo (along with PhRMA, they are one of the biggest, if not THE biggest, lobbying force in DC) and they provide significant campaign contributions. Worse for us, members of Congress have their own privileged health care plan with FEHB, so their experience is insulated from constituents.

If anyone cares to add, revise, amend, or comment - please feel free. I am always open to legitimate education. I only ask that you keep it clean, honest, fact-based and respectful.

Here is the hypocrisy of every GOTP politician, including McConnell and Boehner and Romney - they signed the Gridlock Grover pledge to not raise taxes, and yet they all complain that "half of Americans don't pay taxes", so they promise to "broaden the base" by RAISING TAXES ON LOW AND MIDDLE INCOME WORKING AMERICANS.

Meanwhile, every working American with income under $110,000 pays FICA and Medicare tax on every dollar of income, and their employer pays a match (the full employment penalty tax). All "earned income" (aka work) above $110,000 is exempt from FICA - an incentive to hire fewer workers at higher income. ALL "unearned income" above $0 is exempt from FICA and Medicare tax - an incentive to shift income from salary (that pays up to 35% income tax + payroll tax) to stock, dividends, "carried interest" (that pays 15% income tax + 0 payroll tax).

Some make the dubious claim that a tax on dividend income is "double taxation" because the corporation pays income tax first, the investor second. (Dubious because many corporations pay little to no income tax) Solve the problem by creating a business tax deduction for dividends paid, and apply ordinary income tax for the individual and fund and trust and other entity that receives the dividend, exempt qualified retirement plans.

The truth about conservative opposition to the Affordable Care Act is the tax effect. The Affordable Care Act imposes a new 3.8% tax on individual income above $200,000 including investment income. This tax does not create a loophole or preference based on source of income, i.e. "unearned income." This income remains exempt from FICA and Medicare tax.

All personal income, regardless of source, should be subject to a common progressive tax rate schedule. Reagan tried a tax plan that was essentially flat in 1986, but the top 28% rate was far too low and the resulting deficit was far too high. H.W. Bush addressed this by raising earned income tax (31% "bubble group") while retaining a lower 28% rate for capital gains. H.W. continued to drive high deficits with inadequate revenue. Clinton adjusted the tax rate schedule to be more progressive with higher top rates (while avoiding war) and generated a budget surplus. But he kept the cap gains preference. The separation of capital gains income from working income has been the bane of our tax system ever since as W & Cheney dropped cap gains and dividend income tax rate to 15% while keeping this windfall exempt from Social Security and Medicare payroll taxes. As if this isn't enough, GOTP wants all cap gains and dividends and inheritance/gifts exempt from any tax - permanently!

Romney and his billionaire backers are willing to trash our economy and destroy our middle class to avoid a FAIR tax and hoard ever greater national wealth. Obscene amount of wealth is so valuable to these people that they have pledged to raise a Billion Dollars to feed Superpacs that don't disclose contributors and are unaccountable to honest ethics.

30 years of Tinkle-down economics and the destruction of America's working middle class.

The share of national AGI (adjusted gross income) for the bottom 90% of American taxpayers DECREASED from 67.9% in 1980 to 56.8% in 2009. The share of national AGI (adjusted gross income) for the top 10% of American taxpayers INCREASED from 32.1% in 1980 to 43.2% in 2009 - and most of this income transfer went to the top 1%.

Compared to 1980, 8.4% of 2009 national income was transferred from the bottom 90% of American taxpayers to the top 1%. Total 2009 national AGI was about $7.7 trillion. At 8.4%, almost $650 billion in yearly consumer income was transferred from the bottom 90% of Americans (who drive our consumer economy) to the top 1% (who sequester private wealth) in 2009. This is not just a "middle class" problem - this is at the heart of America's decline.

The top cap gains rate of 15% compared to the top "earned income" rate of 35% is not the fix, it is the problem.

Dividends tax rate of 0% for the first $67,000 and 15% above $67,000 is not the fix, it is the problem.

Eliminating the inheritance windfall tax is not the fix, it is the problem.

Concentrating the FICA tax among workers with income under $110,100 and forcing employers to match it (the employment penalty) is not the fix, it is the problem.

America can grow the economy by rebalancing the income distribution curve with a growth-oriented progressive tax rate schedule that excludes tax preferences and exclusions and loopholes for "unearned income." Revisit the Kennedy/Johnson tax plan from 1964/1965. America's pinnacle of prosperity occurred during the period 1950 - 1980. After 1980, our government changed the rules to benefit wealth over work - our society and economy and government have seen steady decline ever since.

A possible non-symmetric Laffer Curve with a maximum revenue point at around a 70% tax rate,

based on "How Far Are We From The Slippery Slope? The Laffer Curve Revisited" by Mathias Trabandt and Harald Uhlig.[2]

Congress should revisit the Kennedy/Johnson progressive tax rate schedule from 1964/1965. Reduce the number of brackets and adjust for inflation. (the 70% bracket was approximately $1,500,000 adjusted for inflation.) Eliminate tax preferences for "unearned income" and subject all individual income to a common rate schedule.

"How many times have I busted you post copy/pasting Think Progress articles on here?"

Never, because I have not copied and pasted such articles. I don't know what you are talking about, although you may have insulted me under alternate avatars. The writing is my own unless I quote it directly. If I quote it directly, I cite the reference.

Your signature about the megaphone is humorous, given the format of many of your posts. Why do so many GOTP people yell insults instead of offering a factual and logical point? You discredit your movement.

Greed Obstruction Plutocracy. Pledge of Allegiance to Gridlock Grover. GOTP Oath of Obstruction. Party over Nation.

Here is the hypocrisy of every GOTP politician, including McConnell and Boehner and Romney - they signed the Gridlock Grover pledge to not raise taxes, and yet they all complain that "half of Americans don't pay taxes", so they promise to "broaden the base" by RAISING TAXES ON LOW AND MIDDLE INCOME WORKING AMERICANS.

Meanwhile, every working American with income under $110,000 pays FICA and Medicare tax on every dollar of income, and their employer pays a match (the full employment penalty tax). All "earned income" (aka work) above $110,000 is exempt from FICA - an incentive to hire fewer workers at higher income. ALL "unearned income" above $0 is exempt from FICA and Medicare tax - an incentive to shift income from salary (that pays up to 35% income tax + payroll tax) to stock, dividends, "carried interest" (that pays 15% income tax + 0 payroll tax).

Some make the dubious claim that a tax on dividend income is "double taxation" because the corporation pays income tax first, the investor second. (Dubious because many corporations pay little to no income tax) Solve the problem by creating a business tax deduction for dividends paid, and apply ordinary income tax for the individual and fund and trust and other entity that receives the dividend, exempt qualified retirement plans.

The truth about conservative opposition to the Affordable Care Act is the tax effect. The Affordable Care Act imposes a new 3.8% tax on individual income above $200,000 including investment income. This tax does not create a loophole or preference based on source of income, i.e. "unearned income." This income remains exempt from FICA and Medicare tax.

All personal income, regardless of source, should be subject to a common progressive tax rate schedule. Reagan tried a tax plan that was essentially flat in 1986, but the top 28% rate was far too low and the resulting deficit was far too high. H.W. Bush addressed this by raising earned income tax (31% "bubble group") while retaining a lower 28% rate for capital gains. H.W. continued to drive high deficits with inadequate revenue. Clinton adjusted the tax rate schedule to be more progressive with higher top rates (while avoiding war) and generated a budget surplus. But he kept the cap gains preference. The separation of capital gains income from working income has been the bane of our tax system ever since as W & Cheney dropped cap gains and dividend income tax rate to 15% while keeping this windfall exempt from Social Security and Medicare payroll taxes. As if this isn't enough, GOTP wants all cap gains and dividends and inheritance/gifts exempt from any tax - permanently!

Romney and his billionaire backers are willing to trash our economy and destroy our middle class to avoid a FAIR tax and hoard ever greater national wealth. Obscene amount of wealth is so valuable to these people that they have pledged to raise a Billion Dollars to feed Superpacs that don't disclose contributors and are unaccountable to honest ethics.